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Repro. Med 1 > 1st Trimester > Flashcards

1st Trimester Flashcards

1
Q

Are early pregnancies a GYN or OB domain why?

A

GYN

many pregnant don’t make it out of the 1st trimester

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2
Q

the follicles in the ovary are arrested in what stage?

A

prophase of meiosis I

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3
Q

the LH surge causes the oocytes to complete Meiosis I and begin ____

A

Meiosis II

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4
Q

When does the production of progesterone from the corpus luteum begin?

A

just after ovulation

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5
Q

for every primary oocyte ____ mature eggs are produced after LH surge and __ polar bodies are produced

A

1

3

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6
Q

Where does fertilization occur

A

in the tubal ampulla

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7
Q

of the 200-500 million sperm that are ejaculated, only ___ sperm reach the secondary oocyte to attempt fertilization

A

200

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8
Q

the secondary oocyte if fertilized for only __-__ hrs after ovulation

A

12-24

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9
Q

to fertilize, sperm must get through what 3 layers of the secondary oocyte

A
  1. corona radiata (follicle cell layer surrounding oocyte)
  2. zona pellucida (glycoprotein layer surrounding ovum)
  3. oocytes cell membrane
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10
Q

To have the ability to pass through the layer of the oocyte, the sperm must be ____ by losing their ____, these are usually lost in the femal vaginal tract

A

Capacitated

Decapacitation factors
** this must be mimiced for in vitro fertilization to work

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11
Q

Capacitation also causes the ___ to beat more rapidly

A

flagellum

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12
Q

what chemical reaction occurs when the sperm is exposed to glycoproteins

A

acrosomal reaction

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13
Q

Where does the acrosomal reaction occure in the oocyte

A

zona pellucida

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14
Q

the acrosomal reaction Allows sperm plasma membrane to fuse with ovum plasma membrane to…..

A

drop the sperm nucleus into the ovum’s cytoplasm

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15
Q

What happens when the ovum’s cell membrane fuses with the sperm cell membrane

A

Meiosis II re-starts at metaphase and completes, creating another polar body

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16
Q

Fusion with sperm triggers changes that prevent ____

A

polyspermy

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17
Q

The nuclei of sperm and egg are referred to as ____

Each has a ___number of chromosomes, and only one copy of each.

A

pronuclei

haploid

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18
Q

Prior to the nuclei fusing, each one goes through an __ phase.
The 2 nuclei then fuse, and the single cell is called a ___

A

S

zygote

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19
Q

implantation and HcG production occurs ___ days after fertilization

A

7-9

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20
Q

cell division occurs every 12-24 hours

at the 8 cell stage ~ 3 days the cell is called a _____

A

morula

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21
Q

arrival to the uterus / wall occurs about day 6, now the egg is called a ____

A

blastocyst

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22
Q

A blastocysts consists of what?

A

inner cell mass

trophoblast (outer cell)

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23
Q

Does the inner cell mass or trophoblast (outer cell) become the embryo

what does the other thing become?

A

inner cell mass

the placenta and metal membranes (amnion, chorion)

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24
Q

As the trophoblast gains access to inner layers of endometrium they proliferate and create folds called ___(surface area!)
As these cells contact maternal vascular cells, connection is made between ____ and embryonic villi.
At these sites, two cell layers exist between maternal blood supply and embryonic blood supply.
Maternal capillaries proliferate and gradually coalesce, forming ___.

A

villi
maternal capillaries
lacunae

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25
Q

Bleeding in the first trimester happens in ___-___% of all pregnancies. Not all will be lost

A

20% to 25%

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26
Q

Pregnancy loss are ~ __-__% of those who experience first trimester bleeding.

A

25% -50%

*so 50-75% pregnancies will continue

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27
Q

Risk of pregnancy loss or non-viability increases if …. (20

A

Bleeding becomes heavy

Bleeding is accompanied with cramping or pain

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28
Q

Risk of pregnancy loss or nonviability decreases significantly (to 3-7%) if: (2)

A

An intrauterine gestation with + FCA (fetal cardiac activity) is detected

BHCG values rise appropriately for gestational age

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29
Q

What are the DDx of 1st trimester bleeding

A

Normal intrauterine pregnancy
Threatened abortion
Abnormal intrauterine pregnancy
Ectopic pregnancy

30
Q

Urine pregnancy test (UHCG or UPT)

Accurate on first day of ____

A

expected menses

31
Q

βhCG May become positive as soon as __-__ days after ovulation

A

6-8

32
Q

Date of expected menses (@14 days after ovulation) – βhCG is usually ~____ IU/L

A

100 IU/L

33
Q

During the first 30 days of pregnancy (~weeks 3-8) What happens to βhCG levels

A

Doubles every 48-72 hours

34
Q

The two early pregnancy dx tools include

A

HCG and US

35
Q

innocent causes of 1st trimester bleeding

A

cervical ectropion
implantation bleeding
vaginal infection/irritaiton

36
Q

implantation is accompanied by bleeding in ___% of women

A

30%

37
Q

when does implantation bleeding occur how long does it last?

A

occurs: 6-12 days after ovulation (22-25 of cylce

lasts ~3 days

38
Q

what are s/s of implanations bleeding?

A 
meager bleeding (pink or brown coor)
painless
39
Q

the cervix in a cervical ectopy appears _____ because the inner lining of the cervical canal comes out.

A

raw-looking granular appearance

40
Q

The lower limit of hCG at which an examiner can reliably visualize pregnancy on ultrasound. It is ___-____ IU/L with vaginal ultrasound and____-___ IU/L with abdominal ultrasound.

A

1000-2000

5000-6000

41
Q

The absence of a uterine pregnancy with B-HCG above the discriminatory value signifies an _____

A

abnormal pregnancy

usually ectopic or incomplete abortion

42
Q

If β-hCG levels are still below the discriminatory value, what should be done?

A

serial β-hCG’s and ultrasounds should be done bc it indicated an abnormal pregnancy.

43
Q

In a normal pregnancy a ___% or greater increase in serum β-hCG levels should be observed every __ hours

A

66

48

44
Q

What steps should you take if Bleeding occurs in early pregnancy with unknown location of the gestation

A
  1. check serum BHCG
  2. If it is above the discriminatory zone (DZ), an intrauterine pregnancy should be seen.
  3. Then do an ultrasound to see if you see the pregnancy.

** if you cent see anything–> assume ectopic

45
Q

at 5 weeks the BhCG ___ what can be visualized

at 6 weeks the BhCG ___ what can be visualized

at 7 weeks the BhCG ___ what can be visualized

A

> 1500, gestational lab

> 5200, fetal pole

> 17500, cardiac motion

46
Q

spontaneous abortion usually refers to the 1st ____ weeks of pregnancy

A

20

47
Q

If fetus dies in uterus after 20wks GA, it’s called an ___ or ___

A

intrauterine fetal demise (IUFD or FDIU) or stillbirth

48
Q

SAB is likely if..
** know these exist only memorize #1 of Changes in bHCG**

US measurements are

or

Changes in bHCG is
1.
2.
3.

A
  1. 5mm CRL, there is no fetal heart rate
  2. 10mm mean sac diamter, no yolk sac
  3. 20mm mean sac, no fetal pole
  4. <15% rise in bhCG over 48 hrs
  5. gestational sac grwoth <22mm over 5 days
  6. gestational sac growth <3mm over 7 days
49
Q

____ is a normally growing early pregnancy, but with vaginal bleeding

bleeding occurs befor 20th week

other definition: bleeding in early pregancy with no pregancy loss

A

threatened abortion

50
Q

how is threatened abortion diagnosed

A

US or BhCG

51
Q

what are the types of SAB/EPF? (7)

A 
complete
incomplete
inevitable 
chemical prenancy
blighted ovum/anembryonic pregnancy
missed
septic
52
Q

___ is intrauterine pregnancy with cervical dilation & vaginal bleeding

A

Inevitable:

53
Q

___ is an cervix open, some tissue has passed

A

Incomplete:

54
Q

___: is +βhcg but no sac formed

may account for __-___% of all miscarriages.

A

Chemical pregnancy

50-75

55
Q

___ is missed/incomplete abortion becomes infected

A

Septic:

56
Q

___ is a total miscarriage without medications or surgical intervention

A

Complete

57
Q

___ is when an embryo never formed or demised, but uterus hasn’t expelled the sac

A

Missed

58
Q

___ is empty gestational sac, embryo never formed

A

Blighted ovum/anembryonic pregnancy

59
Q

__-___% of all clinically recognized pregnancies end as SAB’s (ACOG)*

___% of these occur in the first 12 weeks

A

10-25

80

60
Q

Probability of 2 consecutive miscarriages is

A

5

Chromosomal or non-chromosomal

61
Q

Up to ____% of SAB’s are due to chromosomal abnormalities
1/2 are trisomies
1/2 are triploidy, tetraploidy, or 45,X0

A

50

62
Q

what are the 6 non-chromosomal causes of SAB

A 
Maternal systemic dz
infectious factors
Endocrine factors 
abnormal placentation
anatomic considerations 
environmental factors
63
Q

Maternal systemic disease causes of SAB include….

A

Antiphospholipid antibody syndrome
lupus
coagulation disorders

64
Q

Infectious factors of SAB include…. (7)

A 
Brucella
chlamydia
mycoplasma
Listeria
toxoplasma
malaria
TB
65
Q

Endocrine factors of SAB include….

A

DM
hypothyroidism
“luteal phase defect” from progesterone deficiency

66
Q

what are environmental factors that case SAB?

A

Smoking >20 cigarettes per day (increased 4X)

Alcohol >7 drinks/week (increased 4X)

Increasing age

67
Q

Management of bleeding without diagnosis of SAB, Pelvic rest (has/has not) been shown to improve outcome

A

HAS NOT

68
Q

Management options for dx’d SAB

A

Uterine evacuation by

  • suction (manual/electric)
  • medication

conservative tx: many will spontaneously complete on their own

69
Q

advantages of surgical management of SABs?

A

ensures products of conception are fully evacuated

minimal anesthesia needed

can often be done in office

women are very satisfied with method

70
Q

what medication is used in the management of SAB?

A

Misoprostol

  • synthetic prostaglandin
  • inexpensive, orally active

Repro. Med 1 (9 decks)

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